BACKGROUNDProton pump inhibitors (PPIs) are widely prescribed, often without clear indications. There are conflicting data on its association with mortality risk and hepatic decompensation in cirrhotic patients. Furthermore, PPI users and PPI exposure in some studies have been poorly defined with many confounding factors.AIMTo examine if PPI use increases mortality and hepatic decompensation and the impact of cumulative PPI dose exposure.METHODSData from patients with decompensated liver cirrhosis were extracted from a hospital database between 2013 to 2017. PPI users were defined as cumulative defined daily dose (cDDD) ≥ 28 within a landmark period, after hospitalisation for hepatic decompensation. Cox regression analysis for comparison was done after propensity score adjustment. Further risk of hepatic decompensation was analysed by Poisson regression.RESULTSAmong 295 decompensated cirrhosis patients, 238 were PPI users and 57 were non-users. PPI users had higher mortality compared to non-users [adjusted HR = 2.10, (1.20-3.67); P = 0.009]. Longer PPI use with cDDD > 90 was associated with higher mortality, compared to non-users [aHR = 2.27, (1.10-5.14); P = 0.038]. PPI users had a higher incidence of hospitalization for hepatic decompensation [aRR = 1.61, (1.30-2.11); P < 0.001].CONCLUSIONPPI use in decompensated cirrhosis is associated with increased risk of mortality and hepatic decompensation. Longer PPI exposure with cDDD > 90 increases the risk of mortality.
Objectives: Recently, the model for End-Stage Liver Disease (MELD) was proposed for the prediction of survival in transjugular intrahepatic portosystemic shunt (TIPS) patients. We therefore compared the prognostic accuracy of the MELD model and the Child-Pugh score, in an unselected cohort of TIPS patients followed long-term. Methods: A retrospective chart review and statistical analyses were done on 120 patients consecutively admitted for portal hypertension from 2009 to 2013 in the Jinling hospital (Nanjing, China). Results: The survival rate for all patients was 95.8% at 3 months, 90% at 1 year, and 85.8% at 3 years. Signifi cantly lower survival rates were found in patients with MELD scores of 15 or more in comparison to those with MELD scores of 15 or less (p<0.001).There was no signifi cant difference in survival rate between patients with Child-Pugh classifi cation A and those with Child-Pugh classifi cation B, while the patients with Child-Pugh classifi cation C has a signifi cantly lower survival rate than those with Child-Pugh classifi cation A and B (p<0.001). The discrimination powers of MELD (c statistics: 0.772, 0.680, 0.647 for 3-month, 1-year, and 3-year survival) were not signifi cantly different from the discrimination powers of Child-Pugh score at the same time points (c statistics: 0.795, 0.732, 0.678). Conclusions: The Child-Pugh classifi cation is only slightly superior to the MELD score for the prediction of long-term survival in TIPS patients. Therefore, the search continues for an entirely new scoring system to further improve prognostic accuracy.
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